MAPA 5310 Scope of Work
Information collected from this form will be included in your contract with MAPA. It will be used as part of our reporting to the FTA on 5310 grant performance. This form was last updated 07/11/2023.
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Recipient and Project Information
Legal Name of Your Organization *
Organization Type *
Project Contact *
Who is the best person to contact regarding this project?
Agreement Signatory *
Who from your organization will sign the agreement?
SAM Registration *
Is your organization registered in the US Federal System for Award Management? If so, what is your Unique Entity ID?
Award Amount *
Please enter the amount of your 5310 award. If you do not know the amount, please contact Court Barber (cbarber@mapacog.org).
Service Provider *
Does your organization provide service in-house, or do you contract with a 3rd party?
Project Expenses *
Only direct labor expenses, 3rd party contract costs, and indirect costs are allowed for reimbursement. Please select which you intend to submit during the agreement. Your organization is eligible for reimbursement of indirect costs if it has an indirect cost rate and cost allocation plan approved by a cognizant federal agency in accordance with 2 CFR 200. You must provide us with a copy of your approved rate and plan. If you do not have a federally approved indirect cost rate, then in accordance with 2 CFR 200.414(f) and 2 CFR 200.403, the indirect cost rate shall be 10% of eligible modified total direct costs (MTDC) that are eligible.
Required
5310 Eligibility *
How does this program serve the needs of transit-dependent populations (specifically seniors and persons with disabilities) beyond traditional public transportation services and Americans with Disabilities Act (ADA) service?
Service Area *
Please describe the area served by your transportation program, including any restrictions on pickup locations, drop-off locations, and trip types.
Budget Information
Personnel *
List employees who will be included in invoices for reimbursement and describe their contributions to the project.
Program Income *
How does your program generate income? Select all that apply.
Required
Matching Funds *
What is the source of the funds you will use to match the federal 5310 funds?
Required
Deliverables
Estimated Number of Trips *
Provide an estimate of the number of individual trips to be made within the scope of this award. This means the number of times a person is given a ride. For example, a vehicle carrying one person from home to an appointment is one trip; a vehicle carrying three people from their homes to appointments is three trips. Return trips count separately so an individual going from home to an appointment and then back home counts as two trips. Plan to include this information in your progress reports. You should be able to track progress.
Other
Are there any additional deliverables you intend to provide upon completion of the contract?
Attachments
Please send the following items to MAPA via email - cbarber@mapacog.org

- Budget Spreadsheet
- Proof of Insurance
- Certifications and Assurances
- Most Recent Independent Financial Audit Report

The budget spreadsheet and certifications and assurances can be found on MAPA's 5310 Awardee Resources page under Pre-Contract Steps:
http://mapacog.org/fta-section-5310-program/section-5310-awardee-resources/

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